Abstract
BACKGROUND: In the United States, aspergillosis and mucormycosis are associated with substantial healthcare costs and mortality. Recent nationally representative data about hospitalisations for these infections are limited, though several reports specifically describe increases in COVID-19-associated aspergillosis and mucormycosis, likely because of critical illness-related immune dysregulation and treatments involving systemic corticosteroids. OBJECTIVES: To update disease burden estimates, we describe trends in aspergillosis-related and mucormycosis-related hospitalisations (A-RH and M-RH). METHODS: We used the 2016-2021 Healthcare Cost and Utilisation Project National Inpatient Sample and U.S. Census Bureau data to calculate A-RH and M-RH rates, examining annual trends, overall and stratified by demographic characteristics. We examined A-RHs and M-RHs during 2020-2021, comparing features and in-hospital mortality for those with vs. without COVID-19. RESULTS: During 2016-2021, an estimated 86,570 A-RHs occurred, with rates (per 1,000,000 population) stable from 2016 to 2019 (range: 42.3-44.5) and increasing from 40.1 (2020) to 51.5 (2021). An estimated 8565 M-RHs occurred, with rates increasing from 3.8 to 5.8. During 2020-2021, 6025/24,285 (24.8%) of A-RHs and 420/2920 (14.4%) of M-RHs were COVID-19-associated. A-RHs and M-RHs involving COVID-19 had mortality rates exceeding 50%, which was ≈3 to 4-fold higher than those for A-RHs and M-RHs without COVID-19. CONCLUSION: Rates of A-RHs and M-RHs in the United States peaked in 2021, likely reflecting the increased burden of COVID-19 in 2021 compared with 2020. Ongoing monitoring of risk factors and clinician awareness is essential for managing and preventing these infections.